Recursive Frame Analysis of a Single Session Client
Shawne S. Ortiz
Our Lady of the Lake University
Introduction
Historical Perspective
Postmodern theories assume that there is not one universal truth and the meanings that people make of their worlds are socially constructed (Parry & Doan, 1994; Smith & Nylund, 1997). Social construction happens in the linguistic interaction that individuals have with others in their environment. Within these interactions people create or attach meaning to descriptions of events that surround problems. The therapist’s role is that of a participant in the linguistic and social interaction with the client that opens space for different interactions or meanings to be constructed (Anderson & Goolishian, 1988).
Postmodern theories assume that the individual has the strengths and resources to resolve problems in his or her life. Problems form because human beings get stuck in a pattern of problem behavior and are unable to recognize their resources that are available to solve the problem. The postmodern therapist is interested in the client’s perception and description of the problem and the possible steps to resolve it. MRI was the beginning of the postmodern theories and was developed as a way to work with families in a brief way utilizing a multidisciplinary approach. The theoretical underpinnings are based on the philosophy of Milton Erickson and Jay Haley and began with the work of Paul Watzlawick, John Weakland, and their colleagues at the Mental Research Institute (MRI) at Palo Alto, California in the late 1950’s (Watzlawick, Weakland, & Fisch, 1974; Weakland, Fisch, Watzlawick, & Bodin, 1974). The postmodern theories of MRI, Solution-Focused and Narrative have distinguished themselves from modern therapies in that they do not subscribe to the disease model that assigns pathology to the clients. These theories liberate the therapist by allowing him or her to take a not knowing, non expert stance in helping clients resolve their own problems (DeJong & Berg, 2002; Hoffman, 1990). Postmodern theories agree on the assumption that problems are developed and maintained in problem saturated discourses. The reality of each client is created socially through linguistic interaction with their system. Perceptions of events or life stories are not created in a vacuum; rather, in the stories that we tell ourselves and others to explain those events. In focusing on the client as the expert of their life story, we reinstate the idea that the client holds the keys to solving his or her own problems (Monk, Winslade, Crocket, & Epston, 1997). The therapist simply assists the client in investigating solutions to the identified problem.
MRI, Narrative therapy and Solution-Focused therapies are present oriented allowing for focus on what is creating problems for the client in the present; employ interactional concepts rather than intrapsychic; stress task orientation; and goal formation in observable, behavioral terms (Fisch, 1994). These therapeutic styles are also unique in that they all maintain the idea that the client holds the key to problem dissolution. In these models of therapy, the therapist employs a not knowing or curious stance in approaching the eliciting of solutions from the client. The client is the knowledgeable party and holds the strengths, resources, and answers to the presenting problem. All three models are brief in that goal formation happens early in the therapeutic process and treatment can be as short as one session. The client determines when goals are reached and when termination will occur. Therefore, the issue of termination is usually mentioned in the first session.
Solution focused therapy (SFT) focuses on the present and the problem identified by the client. Solution focused therapy also works on the assumption that clients are experts in their lives and have the resources to solve their problems. Clients are asked to identify and describe the problem in order to provide information on the perception of the problem and how the client will know it is solved. According to SFT, problems are maintained by limiting solutions. People keep doing the same thing everyday because they don’t consider any other option (De Shazer, Berg, Lipchik, Nunnally, Molnar, Gingerich, Weiner-Davis, 1986). In moving in the direction of solutions, the clients are not asked to focus on the problem but on the absence of the problem. What will be happening, what will you be doing when the problem is solved? This type of exploration allows the client to envision his/her life without the problem. Solution talk is initiated as soon as possible in the first session with the client. However, the client is the expert and controls the directions and focus of the session. The goal of therapy is to utilize the clients’ language to find out what’s going right and to continue doing what works. Goals build the expectation that change will happen and keep focus of therapy on the absence of the complaint which is drawn out with the identification and elaboration of exceptions (De Jong & Berg, 2002). Major Influences
According to Insoo Kim Berg (n.d), in an essay posted on the Brief Family Therapy Center website, the work of Paul Watzlawick, John Weakland, Richard Fisch, and their colleagues at the Mental Research Institute (MRI) at Palo Alto, California, greatly influenced the development of solution focused therapy as it is practiced today (Berg, n.d.; De Shazer et al., 1986). In addition to the MRI group, Gregory Bateson’s work on communication and the idea that learning and reality are subjective and individuals learn as constant comparison of events across time contributed to Steve De Shazer’s work on SFT (De Jong & Berg, 2002; Lipchik, 2002). Besides Bateson, Milton Erickson’s work on the use of the client’s language to facilitate change by entering their world played a part in the evolution of solution focused therapy (De Jong & Berg, 2002). Another major voice in brief therapy and solution focused therapy is Jay Haley whose work with strategic family counseling based on Ericksonian principles took into account the social context in which problems evolved (Haley, 2007). The work of Eve Lipchik, Michelle Weiner-Davis, Bill O’Hanlon, John Walter, and Jane Peller has also expanded the literature and use of solution focused therapy.
Theoretical Basics Problem Formation As humans we live in a social world in which relationships are of primary importance in the meanings we create about our world. These relationships consist of contact with others which are often helpful and assist us in resolving our day to day problems. However on occasion these interactions create or maintain problem behavior or talk limiting the identification of solutions. Problems are viewed as occurring in the context of these social interactions rather than as an inherent defect in the client (De Shazer et al., 1986; Lipchik, 2002). Problems develop when past successful behaviors are abandoned during a change in circumstances. The client(s) may have overlooked how to apply existing skills to the new contextual changes in relationships. In addition clients often focus on the past unsuccessful events in their lives and overlook their inherent resources, strengths, and successful solution attempts. Problem Maintenance Problems are created and maintained in the context of human interactions (De Shazer et al., 1986; Lipchik, 2002; Saggese & Foley, 2000). Within these interactions there is a position of comfort in doing things that have worked well in the past in response to a problem. When client’s present for therapy they often provide a description of the problem and can stay focused in the problem talk. In addition this focus maintains the problem because clients want to determine the cause of the problem when the solution can have little to do with the problem (Lipchik, 2002). Clients come to therapy wanting to change but their attempts may have inadvertently made the problem worse or created a pattern of bad habits. Problems are maintained when clients continue trying the same unsuccessful solutions to their problems. They are often unable to access past strengths to use in problem resolution because they are stuck in the current attempted, but unsuccessful, solution pattern. Problem Resolution
In conducting solution focused therapy, it is important to keep the clients in the expert position. A solution focused therapist would do this by inviting clients to explore their own agency by being in the not knowing position. This allows clients to remain the authority and keeps the focus on their perceptions of their own successes and strengths. Their perceptions, influenced by cultural, social, and interpersonal interactions, are what form the solutions that are going to create the change that is important for them to resolve problems. In using solution-focused therapy we focus on the presenting problem and then shift to solution focused talk. It is not necessary to expand on the history or possible causes of the problems. We are going to look for solutions to the identified problems without getting bogged down in the details of why the problem is created. Problems are resolved when clients access previously overlooked or abandoned strengths and resources to do more of what works. Once a small positive change is made, the client is more optimistic and confident about tackling further changes.
Case Analysis
John is a 19 year old Hispanic male who was a walk in client on my summer team at Community Counseling Services. When he initially came in to the clinic there was no one available to see him at the time so he was asked to return a couple of hours later. He agreed and took the paper work to fill out so that when he returned he could be seen as soon as possible. John was brought to the clinic by his girlfriend and mother who were very worried about him because he was very “depressed” and they were worried that he would hurt himself. He appeared to be in crisis as he talked about “breaking down” in the parking lot at CCS. John was very soft spoken and kept his head down in his hands.
Since John presented as a walk-in client we as therapists approached the session from a single session perspective. We were aware he was brought in at the insistence of his mother and girlfriend and knew there was a possibility he may not return for additional sessions. Knowing this we wanted to make sure we could be as helpful as possible in just one session. The session began with the review of the informed consent forms because he stated he did not understand them. We reviewed these forms with him thoroughly which I think helped to allay his fears a bit. We knew he was brought to the clinic by his family who were in the waiting room and we asked them if they would like to participate in the session. Both his mother and girlfriend declined stating he was the one who needed counseling. Presenting Gallery:
John comes into the session and provides a list of problems to the therapists. He repeatedly stated that he just did not know what to do. We as therapists working from a solution focused perspective attempt to clarify what he hopes to get out of coming into the clinic today. Through out the session he repeatedly says that “he can’t do anything.” He also says repeatedly that “it has been a bad day for me.” We explore with him what that means. Shawne: I um, just really wanting to know what made you decide to come into counseling today. Client: Uh, I’m looking for some answers. I’ve been having a lot of problems with jobs and stuff. I can’t, I have a daughter and I can’t because it’s a lot of pressure. Shawne: Yeah, Client: I had two jobs and I and they both fired me. Shawne: Oh, ok. Client: And they like, basically I’m in a hole and I can’t, I just can’t deal with it. I just feel like the world has screwed me over and I yelled earlier. I told, I told my wife and my mom to just leave me alone and I came here. Shawne: Ok. Client: Because I listened to them and I’d rather not go off. Cause I used to be a cutter and I used to cut myself. So, I’d rather not do that anymore.
Comments: We recognized John was feeling really hopeless and were concerned that he may be as risk for suicide but at the session continues he discusses his daughter and how important it is that he is around to see her grow up. He also stated he does not cut himself anymore because he does not want his daughter to see him doing this. We are already seeing exit markers from the presenting gallery into the resource gallery. However John is not yet ready to exit the presenting gallery. Shawne: Oh Client: Since my daughter was born, I’d rather pick to help myself instead of Brandy: that’s great. Client: Like I feel ashamed because I can’t make enough money right now. I uh totaled my car, I have a bunch of stuff happening
Comment: Here he talks about lending his car to his friend who totaled his car then left it to get towed away. He is really upset about this because it was his only mode of transportation and as a result he has lost his jobs since he has no way of getting to them on time. Shawne: Oh my goodness so you have a lot of things going on, and it seems like all at once. Client: I’m sorry, I’m sorry for not looking up so much but Shawne: That’s ok. Brandy: That’s fine. Client: Just been a bad day for me. My friend got killed a couple, on my birthday actually (laughs). Shawne: Oh my goodness. Client: On April the seventh Client: I don’t know. Brandy: That must have been really hard. Client: Kind of. Shawne: Yeah, it sounds like it’s been hard for you. Client: My girl was just really worried. She don’t want me to hurt myself. I’m not saying I am but I’m just saying that she thinks, but I’m not like that no more. Cause Shawne: Uh, hmm Client: I’m not going to see my baby grow up. Resource Gallery
In the examples we include here we attempt to elicit exceptions and strengths of the client. Through out the session he discusses working two jobs and taking care of two households. He does not recognize as these things as successes. He also talks about what he does to be a good father to his child. He says that he and his girlfriend do not fight in front of her because he does not want her to see them arguing. He also said that he attempted to go to college but do to transportation issues he had to postpone his education. He also talks about running his own business and how important that is to him. This section shows how we open the door to the resource gallery that holds his strengths and successes. Shawne: Yeah, I agree, but you said you were holding two jobs. I find that really impressive because you got your girlfriend, you’ve got your baby, and then you were able to hold two jobs Client: I was never home though Shawne: Oh, ok. Client: Well where she lives is not my home. My home is with my mom. Shawne: Oh, ok. Client: But I hold two jobs so I can pay my mom and my girlfriend. Shawne: Yeah. Client: Cause I got to buy diapers, I got to buy wet wipes, I got to buy lots of stuff for her even her clothes. Shawne: Yeah Client: She’s growing and my mom she needs food for the house and other stuff like that Shawne: Wow.
Comment: John states he works two jobs to support two households. He talks about not being good father because he was never there. We reframe the idea of what it means to be a “father” and point out that he is supporting his daughter by providing the things she needs to be healthy. He seems to accept this but is still reluctant to believe he is a good father. He also states he has always worked and that his brothers and step father tell him to just deal with it like he has before because he has always managed to take care of his family. Brandy: You said that um that your stepdad said that um, you’d gotten on your feet before Client: Yeah Brandy: And what do you think that you did before that you might not be doing now that might could help you to get back on to your feet Client: I don’t know how I got, oh my mother in law, she, she gave me a car without a motor. And I put a motor in that car and that was my car. Client: And that’s what, what helped me out. But I actually I was making money pretty good a long time, at least two years Shawne: Wow they (the team) wanted to know is, they’re kind of curious about is with all these things that you say you’ve got going on, how have you managed to do as well as you’re doing? Client: Not giving up. Shawne: Not giving up. Client: Like I think, cause my uncle put it to me like you got a will there’s a way. Shawne: Uh hmm Client: I don’t stop trying but earlier I was breaking down and crying. And they took me here and I still feel like crap you know. Shawne: Yeah Client: But like I haven’t broke down like that since I was really little and they’re really worried about me and that’s why they took me here. Shawne: Yeah Client: And that’s why. I guess their just afraid for me not trying.
Comment: John uses the term “not trying” rather than saying he has given up. For me this suggests this is only a temporary state of affairs. He has provided many exceptions to the contrary where he continues to “try” in spite of all the difficulties he’s facing. Just in coming into therapy today he continues to try and make things better. We reflect this to him but he is hesitant to accept this as a personal strength. Shawne: But it sounds like you do keep trying even when these things happen to you that. Like you said you lose everything and then you overcome it and you keep on and you work and it sounds like you take care of your daughter and you take care of your mom. Client: But that the reason I’m working because of her. And I don’t know I guess, I guess, I don’t want to, I don’t want to quit because of my baby girl. Shawne: Yeah, and you don’t sound like the type of person that’s a quitter anyway. Brandy: I agree Shawne: Yeah, it doesn’t sound like that would even be something you could do. Brandy: I mean it seems like everybody in your family thinks you’re a strong willed person. Shawne: Uh hmm, and that you get on your feet by your own work. Client: Yeah Shawne: Yeah and so I Client: It was my mother in law that helped me the first time. I just Shawne: Uh hmm Client: Today when I was crying in the middle of the parking lot I was just like there’s nothing I can do. I felt like I can’t, I still feel like that a little. It’s like no matter how hard I try. Shawne: Uh hmm Client: Yeah. That really what I got to say cause that’s everything that’s bothering me, almost everything. Shawne: Yeah. That’s a lot of stuff, and that’s why I’m still like wondering how, with all that stuff, you’re still even able to get up, even come back over here. I mean you could have said yeah, I’ll be back and then Brandy: Not show up. Shawne: Not show up but you still came back. That to me shows that you’re the kind of person that doesn’t quit and a responsible guy. I mean if you say you’re going to do something then you going to do it.
Comments: At this time he states that when he was not seen immediately his mother and girlfriend took him to talk to a priest. He said it helped him a little and that is why he was able to come back to counseling. He also talks more about his brother in law. He said he is trying to get his landscaping company of the ground and he had gotten paid for a job. He said he gave his brother in law his half of the money but he did not show up to help him finish the job. He said he could not face having to do the work himself and that was one of the reasons he was at the clinic today. He said his brother in law told him he was hung over and could not work. He said he was contemplating firing him but then his girlfriend would be mad. Client: I just don’t know what to do like, if I fire him he has two kids, I have one. Shawne: Uh hmm Client: If I fire him, she’s going to get mad at me. I’m just you know I can’t help it. I just, I don’t know what to do. I would like ya’lls opinion. Should I fire him? I don’t know cause, that’s one of, that’s one of my problems. Shawne: Yeah. Client: I don’t know what to say like this. Its I think I should because that would be a good bosses decision but that would be a brother in law decision would be no. You know what I mean? Shawne: Uh hmm
Client: Like its like a split down the middle, like I don’t know what to do. Shawne: Yeah. Client: So I didn’t go work today I actually came here. This is where they took me. My girlfriend told my mom, which I obey my moms every word, I just came here. I just don’t know what to do from here now. Shawne: Yeah. Well it sounds like you have an idea of what you should do to me.
Comment: Here we reflect the ambivalence he is feeling regarding what to do about his brother in law. He has made a case to us as to why he should fire his brother in law but still concerns himself with how that will make the brother in law feel. In making the case for firing him he appears to have made a decision about what to do and is struggling with how to go about doing it. He struggles between being a boss and a brother in law. We continue to elicit exceptions such as his compassion and reasoning skills. We continue to support his position as expert. Client: A little one but like Shawne: Yeah and that’s why I’m sure you’ve heard this before they say you shouldn’t do business with family. I’m mean we’ve all done it don’t get me wrong. I mean we’ve all done it and we think man how to we get out of this now without you know making so and so mad, and hurting this person and it can be hard. And so I can understand why you having such a hard time with it but like you said you also have a child to take care of and raise, and that you want to make money for and it sounds like you make pretty good decisions when it comes to those things. And knowing that, that you’re a good decision maker and you’re a responsible person, I think you are the best judge of what to do in that situation. Therapeutic Gallery
At this point we enter into the therapeutic gallery when we recognize and reaffirm John’s good decision making skills. We help him acknowledge that he has already made his decision, and because he’s such a good decision maker, it will be the right decision for him. We also normalize the conflict he feels about the decision he has to make and that his feelings about his situation are understandable. We also assign him homework that will help him plan how to communicate with his brother in law. By the end of the session he states he “still feels like crap,” however it is less than when he entered the session. Client: like the me you see right now is not me. When I’m cutting yards and then getting customers and stuff I’m actually in your face, how’s it going, you know stuff like that. Shawne: (the team phones in) that was the team and they had a couple of questions um, kind of some stuff they were curious about because of the things that you had mentioned and um one of them was because you seem to be looking kind of for feedback and for advice, and they were just wondering if you could ask the friend who passed away for advice, what do you think he would tell you about what you’re going through now? Client:Man, I miss that dude, he would tell me to ignore it and keep on going and then we’d kick it and play basketball or something. Shawne: Yeah Client: That’s what he would tell me. Shawne: Yeah. Client: I its just, I guess, I guess I ya’ll know what ya’ll talking about because that fool was a really close friend of mine. Shawne: Uh hmm. And it sounds like it the way you talked about him. Even though you talked about him just for a moment you could tell that person was that he was important and still is to, you know, to a certain degree in your life. Client: Yeah my friend was a good guy, he didn’t deserve to get shot. Shawne: Well it took a little bit longer but the team really had a lot of feedback and a lot of things they wanted to say um. And first and foremost they understand that this has been a bad day for you and you’ve got so many things going on that you’ve mentioned. You know you’re talking about possibly firing your brother in law, and then the money issue, and then the loss of your friend. It seems like you’ve had a lot of losses so even though you may not agree with what the teams feed back is, we did want to um share it with you and that they feel that in spite of all that stuff you have a lot going for you. They have a lot that they want to praise you for in the sense that you’re responsible, you put your daughter first and foremost even though you’ve got all these things going on for yourself. That you worry about how other people are going to feel even though you need to do what’s right for you as well. You’re looking at your brother in law even though you said he’s been a bad employee your still concerned about him and his family. And so they were really just impressed with um everything you’re managing to do in spite of the losses. And they recognize that because it’s been such a bad day you might not see it that way right now, but Client: Yeah, I understand Shawne: Yeah but they wanted for us to share that with you because they were just so impressed and they felt that you have a lot of things to really hold your head up high about because your able to, able to still put your daughter first, and take care of her and worry about all those things that a father does. Even though you say you can’t be there you say you’re still working to provide her diapers, and food, and clothes, and all those things that are important to raise a healthy baby. So, I mean it sounds like you have an idea of what you should be as a father, but your doing those things by working and providing and trying to do the best even with the situation as it is. So they were just really you know impressed with how you really want to set that good example for your daughter. And so they wanted, they wanted to share that with you. Client: Yeah, that’s nice Shawne: And to let you know that you do have a lot of things to hold your head up high about. Having talked about your brother in law, you kind of like I said, already made a decision, so maybe the best thing for you to do at this point is just to figure out the best way to talk to him that’s going to make you feel okay with it. You know what I’m saying. Do it in a way that you think, you know what I said what I had to say, in the right way, you know with respect, and with kindness and now that’s the way it going to be. And he’ll have to deal with his feelings but Client: Yeah that’s true Shawne: You want to say it in a way where you feel you know what I did it the right way, I did it in the best way and that’s all you can do. Client: Yeah cause he didn’t work out right. Shawne: Yeah Client: I don’t have to feel bad Shawne: Uh hmm, but you don’t have to do it in a way that says you know Client: I know I’m going to ask you a stupid question but the point is I just don’t want to feel bad. Shawne: Of course but I don’t know if that
Client: Is it worth it Shawne: If that’s realistic. I mean you told us, you made a good case to us why you should fire him Client: Yeah Shawne: So you are just going to Client: That’s because I was mad about it, when I was mad I was just like Shawne: And now that you’re a little bit calmer, and you’ve thought about it, you can do it in a way that is more I guess professional, like an employer would do. Client: Yeah Shawne: Cause you’ve got to take care of yourself Client: Yeah, I’m letting you know something don’t hire him. Thank you for talking to me. At the end of the session he states that he will make an appointment for 3-4 weeks out which really surprised us. We assumed because he felt his situation was so bad and he stated he was depressed he would need to return sooner. He then decided he had gotten what he needed which was to be reassured about his decision to fire his brother in law and he would call if he needed another appointment.
Another surprise is that right before leaving the room John tells us he is uncomfortable talking to women because of the relationship he has with his sisters. We assured him that he could see a male therapist in the future if that would be helpful for him so he could return for another session. He assured us we were helpful to him and he did not feel he needed to schedule another session at this time.
John was a client who presented with so many problems that it would appear his case could not be addressed much less helped in a single session. Even as we began the session we were unsure if there was going to be anything we could do in one hour that would be helpful to him. He was easy to work with in that he had numerous exceptions and strengths which allowed us to move through from the presenting gallery, through the resource gallery to the therapeutic gallery with relative ease. He provided several exit markers from gallery to gallery however there were times in which he was not ready to move through those exits. Early on in the session he would exit the presenting gallery to the resource gallery only to reenter the presenting gallery by providing a new problem frame. It was more of a revolving door between the presenting and resource galleries. As we moved through the session the exit doors were able to be closed and we moved forward to the therapeutic gallery. By the end of the session he was able to smile and made eye contact before leaving the session.
Graphic Representation of Analysis
Presenting Gallery
Doing
·Lost both jobs ·Not spending time with daughter ·Being financially strapped ·Kicked out of school ·Car was totaled and towed away ·“Went Off” ·Yelling at Mother and Girlfriend
Viewing
·“ I’m in a hole” ·Can’t do anything ·Feeling ashamed ·Inferior ·Feel like the world has screwed him over ·No one can help him
Problem/Not a problem
·Lost his job ·Financially strapped ·Idea of “Father” ·Deciding whether or not to fire his brother in law ·Best Friend killed ·Finds out information about girlfriend ·Transportation
Interactions
·Yelling at Mother and Girlfriend ·Breaking down and crying ·Asking for help ·Interactions with brother in law
Resource Gallery
Solutions/Exceptions
Continuing to work
Coming to counseling
Talking to priest
Listening to his mother
Supporting two households
Seeking help instead of cutting or hurting himself
Successful/Unsuccessful
Held two jobs
Tried to better himself by going to college
Overcame history of cutting
Started his own business
Strengths
Good decision maker
Puts his daughter first
Asks for help
Has supportive family
Responsible
Therapeutic Gallery
Goals
Not feel bad about firing brother in law
Be a good father for his daughter
Keep doing landscaping business
Intervention/homework
·Find a way to fire brother in law in a way that he feels good about ·Ask his friend who passed away for advice ·How has he managed to do as well as his has?
Frames and reframes
·Client: I was never around for my daughter because I was always working oTherapist: You were working to provide all the things your daughter needs to be happy and healthy ·Client: I need advice on firing brother in law oTherapist: Seems like you already made a decision and need to find a way to tell him that you feel ok with ·Client: I can’t do anything oTherapist: You have managed to have two jobs, take care of a daughter, start your own business, and make good decisions
References
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Recursive Frame Analysis of a Single Session Client
Shawne S. Ortiz
Our Lady of the Lake University
Introduction
Historical Perspective
Postmodern theories assume that there is not one universal truth and the meanings that people make of their worlds are socially constructed (Parry & Doan, 1994; Smith & Nylund, 1997). Social construction happens in the linguistic interaction that individuals have with others in their environment. Within these interactions people create or attach meaning to descriptions of events that surround problems. The therapist’s role is that of a participant in the linguistic and social interaction with the client that opens space for different interactions or meanings to be constructed (Anderson & Goolishian, 1988).
Postmodern theories assume that the individual has the strengths and resources to resolve problems in his or her life. Problems form because human beings get stuck in a pattern of problem behavior and are unable to recognize their resources that are available to solve the problem. The postmodern therapist is interested in the client’s perception and description of the problem and the possible steps to resolve it. MRI was the beginning of the postmodern theories and was developed as a way to work with families in a brief way utilizing a multidisciplinary approach. The theoretical underpinnings are based on the philosophy of Milton Erickson and Jay Haley and began with the work of Paul Watzlawick, John Weakland, and their colleagues at the Mental Research Institute (MRI) at Palo Alto, California in the late 1950’s (Watzlawick, Weakland, & Fisch, 1974; Weakland, Fisch, Watzlawick, & Bodin, 1974).
The postmodern theories of MRI, Solution-Focused and Narrative have distinguished themselves from modern therapies in that they do not subscribe to the disease model that assigns pathology to the clients. These theories liberate the therapist by allowing him or her to take a not knowing, non expert stance in helping clients resolve their own problems (DeJong & Berg, 2002; Hoffman, 1990). Postmodern theories agree on the assumption that problems are developed and maintained in problem saturated discourses. The reality of each client is created socially through linguistic interaction with their system. Perceptions of events or life stories are not created in a vacuum; rather, in the stories that we tell ourselves and others to explain those events. In focusing on the client as the expert of their life story, we reinstate the idea that the client holds the keys to solving his or her own problems (Monk, Winslade, Crocket, & Epston, 1997). The therapist simply assists the client in investigating solutions to the identified problem.
MRI, Narrative therapy and Solution-Focused therapies are present oriented allowing for focus on what is creating problems for the client in the present; employ interactional concepts rather than intrapsychic; stress task orientation; and goal formation in observable, behavioral terms (Fisch, 1994). These therapeutic styles are also unique in that they all maintain the idea that the client holds the key to problem dissolution. In these models of therapy, the therapist employs a not knowing or curious stance in approaching the eliciting of solutions from the client. The client is the knowledgeable party and holds the strengths, resources, and answers to the presenting problem. All three models are brief in that goal formation happens early in the therapeutic process and treatment can be as short as one session. The client determines when goals are reached and when termination will occur. Therefore, the issue of termination is usually mentioned in the first session.
Solution focused therapy (SFT) focuses on the present and the problem identified by the client. Solution focused therapy also works on the assumption that clients are experts in their lives and have the resources to solve their problems. Clients are asked to identify and describe the problem in order to provide information on the perception of the problem and how the client will know it is solved. According to SFT, problems are maintained by limiting solutions. People keep doing the same thing everyday because they don’t consider any other option (De Shazer, Berg, Lipchik, Nunnally, Molnar, Gingerich, Weiner-Davis, 1986). In moving in the direction of solutions, the clients are not asked to focus on the problem but on the absence of the problem. What will be happening, what will you be doing when the problem is solved? This type of exploration allows the client to envision his/her life without the problem. Solution talk is initiated as soon as possible in the first session with the client. However, the client is the expert and controls the directions and focus of the session. The goal of therapy is to utilize the clients’ language to find out what’s going right and to continue doing what works. Goals build the expectation that change will happen and keep focus of therapy on the absence of the complaint which is drawn out with the identification and elaboration of exceptions (De Jong & Berg, 2002).
Major Influences
According to Insoo Kim Berg (n.d), in an essay posted on the Brief Family Therapy Center website, the work of Paul Watzlawick, John Weakland, Richard Fisch, and their colleagues at the Mental Research Institute (MRI) at Palo Alto, California, greatly influenced the development of solution focused therapy as it is practiced today (Berg, n.d.; De Shazer et al., 1986). In addition to the MRI group, Gregory Bateson’s work on communication and the idea that learning and reality are subjective and individuals learn as constant comparison of events across time contributed to Steve De Shazer’s work on SFT (De Jong & Berg, 2002; Lipchik, 2002). Besides Bateson, Milton Erickson’s work on the use of the client’s language to facilitate change by entering their world played a part in the evolution of solution focused therapy (De Jong & Berg, 2002). Another major voice in brief therapy and solution focused therapy is Jay Haley whose work with strategic family counseling based on Ericksonian principles took into account the social context in which problems evolved (Haley, 2007). The work of Eve Lipchik, Michelle Weiner-Davis, Bill O’Hanlon, John Walter, and Jane Peller has also expanded the literature and use of solution focused therapy.
Theoretical Basics
Problem Formation
As humans we live in a social world in which relationships are of primary importance in the meanings we create about our world. These relationships consist of contact with others which are often helpful and assist us in resolving our day to day problems. However on occasion these interactions create or maintain problem behavior or talk limiting the identification of solutions. Problems are viewed as occurring in the context of these social interactions rather than as an inherent defect in the client (De Shazer et al., 1986; Lipchik, 2002). Problems develop when past successful behaviors are abandoned during a change in circumstances. The client(s) may have overlooked how to apply existing skills to the new contextual changes in relationships. In addition clients often focus on the past unsuccessful events in their lives and overlook their inherent resources, strengths, and successful solution attempts.
Problem Maintenance
Problems are created and maintained in the context of human interactions (De Shazer et al., 1986; Lipchik, 2002; Saggese & Foley, 2000). Within these interactions there is a position of comfort in doing things that have worked well in the past in response to a problem. When client’s present for therapy they often provide a description of the problem and can stay focused in the problem talk. In addition this focus maintains the problem because clients want to determine the cause of the problem when the solution can have little to do with the problem (Lipchik, 2002). Clients come to therapy wanting to change but their attempts may have inadvertently made the problem worse or created a pattern of bad habits. Problems are maintained when clients continue trying the same unsuccessful solutions to their problems. They are often unable to access past strengths to use in problem resolution because they are stuck in the current attempted, but unsuccessful, solution pattern.
Problem Resolution
In conducting solution focused therapy, it is important to keep the clients in the expert position. A solution focused therapist would do this by inviting clients to explore their own agency by being in the not knowing position. This allows clients to remain the authority and keeps the focus on their perceptions of their own successes and strengths. Their perceptions, influenced by cultural, social, and interpersonal interactions, are what form the solutions that are going to create the change that is important for them to resolve problems. In using solution-focused therapy we focus on the presenting problem and then shift to solution focused talk. It is not necessary to expand on the history or possible causes of the problems. We are going to look for solutions to the identified problems without getting bogged down in the details of why the problem is created. Problems are resolved when clients access previously overlooked or abandoned strengths and resources to do more of what works. Once a small positive change is made, the client is more optimistic and confident about tackling further changes.
Case Analysis
John is a 19 year old Hispanic male who was a walk in client on my summer team at Community Counseling Services. When he initially came in to the clinic there was no one available to see him at the time so he was asked to return a couple of hours later. He agreed and took the paper work to fill out so that when he returned he could be seen as soon as possible. John was brought to the clinic by his girlfriend and mother who were very worried about him because he was very “depressed” and they were worried that he would hurt himself. He appeared to be in crisis as he talked about “breaking down” in the parking lot at CCS. John was very soft spoken and kept his head down in his hands.
Since John presented as a walk-in client we as therapists approached the session from a single session perspective. We were aware he was brought in at the insistence of his mother and girlfriend and knew there was a possibility he may not return for additional sessions. Knowing this we wanted to make sure we could be as helpful as possible in just one session. The session began with the review of the informed consent forms because he stated he did not understand them. We reviewed these forms with him thoroughly which I think helped to allay his fears a bit. We knew he was brought to the clinic by his family who were in the waiting room and we asked them if they would like to participate in the session. Both his mother and girlfriend declined stating he was the one who needed counseling.
Presenting Gallery:
John comes into the session and provides a list of problems to the therapists. He repeatedly stated that he just did not know what to do. We as therapists working from a solution focused perspective attempt to clarify what he hopes to get out of coming into the clinic today. Through out the session he repeatedly says that “he can’t do anything.” He also says repeatedly that “it has been a bad day for me.” We explore with him what that means.
Shawne: I um, just really wanting to know what made you decide to come into counseling today.
Client: Uh, I’m looking for some answers. I’ve been having a lot of problems with jobs and stuff. I can’t, I have a daughter and I can’t because it’s a lot of pressure.
Shawne: Yeah,
Client: I had two jobs and I and they both fired me.
Shawne: Oh, ok.
Client: And they like, basically I’m in a hole and I can’t, I just can’t deal with it. I just feel like the world has screwed me over and I yelled earlier. I told, I told my wife and my mom to just leave me alone and I came here.
Shawne: Ok.
Client: Because I listened to them and I’d rather not go off. Cause I used to be a cutter and I used to cut myself. So, I’d rather not do that anymore.
Comments: We recognized John was feeling really hopeless and were concerned that he may be as risk for suicide but at the session continues he discusses his daughter and how important it is that he is around to see her grow up. He also stated he does not cut himself anymore because he does not want his daughter to see him doing this. We are already seeing exit markers from the presenting gallery into the resource gallery. However John is not yet ready to exit the presenting gallery.
Shawne: Oh
Client: Since my daughter was born, I’d rather pick to help myself instead of
Brandy: that’s great.
Client: Like I feel ashamed because I can’t make enough money right now. I uh totaled my car, I have a bunch of stuff happening
Comment: Here he talks about lending his car to his friend who totaled his car then left it to get towed away. He is really upset about this because it was his only mode of transportation and as a result he has lost his jobs since he has no way of getting to them on time.
Shawne: Oh my goodness so you have a lot of things going on, and it seems like all at once.
Client: I’m sorry, I’m sorry for not looking up so much but
Shawne: That’s ok.
Brandy: That’s fine.
Client: Just been a bad day for me. My friend got killed a couple, on my birthday actually (laughs).
Shawne: Oh my goodness.
Client: On April the seventh
Client: I don’t know.
Brandy: That must have been really hard.
Client: Kind of.
Shawne: Yeah, it sounds like it’s been hard for you.
Client: My girl was just really worried. She don’t want me to hurt myself. I’m not saying I am but I’m just saying that she thinks, but I’m not like that no more. Cause
Shawne: Uh, hmm
Client: I’m not going to see my baby grow up.
Resource Gallery
In the examples we include here we attempt to elicit exceptions and strengths of the client. Through out the session he discusses working two jobs and taking care of two households. He does not recognize as these things as successes. He also talks about what he does to be a good father to his child. He says that he and his girlfriend do not fight in front of her because he does not want her to see them arguing. He also said that he attempted to go to college but do to transportation issues he had to postpone his education. He also talks about running his own business and how important that is to him. This section shows how we open the door to the resource gallery that holds his strengths and successes.
Shawne: Yeah, I agree, but you said you were holding two jobs. I find that really impressive because you got your girlfriend, you’ve got your baby, and then you were able to hold two jobs
Client: I was never home though
Shawne: Oh, ok.
Client: Well where she lives is not my home. My home is with my mom.
Shawne: Oh, ok.
Client: But I hold two jobs so I can pay my mom and my girlfriend.
Shawne: Yeah.
Client: Cause I got to buy diapers, I got to buy wet wipes, I got to buy lots of stuff for her even her clothes.
Shawne: Yeah
Client: She’s growing and my mom she needs food for the house and other stuff like that
Shawne: Wow.
Comment: John states he works two jobs to support two households. He talks about not being good father because he was never there. We reframe the idea of what it means to be a “father” and point out that he is supporting his daughter by providing the things she needs to be healthy. He seems to accept this but is still reluctant to believe he is a good father. He also states he has always worked and that his brothers and step father tell him to just deal with it like he has before because he has always managed to take care of his family.
Brandy: You said that um that your stepdad said that um, you’d gotten on your feet before
Client: Yeah
Brandy: And what do you think that you did before that you might not be doing now that might could help you to get back on to your feet
Client: I don’t know how I got, oh my mother in law, she, she gave me a car without a motor. And I put a motor in that car and that was my car.
Client: And that’s what, what helped me out. But I actually I was making money pretty good a long time, at least two years
Shawne: Wow they (the team) wanted to know is, they’re kind of curious about is with all these things that you say you’ve got going on, how have you managed to do as well as you’re doing?
Client: Not giving up.
Shawne: Not giving up.
Client: Like I think, cause my uncle put it to me like you got a will there’s a way.
Shawne: Uh hmm
Client: I don’t stop trying but earlier I was breaking down and crying. And they took me here and I still feel like crap you know.
Shawne: Yeah
Client: But like I haven’t broke down like that since I was really little and they’re really worried about me and that’s why they took me here.
Shawne: Yeah
Client: And that’s why. I guess their just afraid for me not trying.
Comment: John uses the term “not trying” rather than saying he has given up. For me this suggests this is only a temporary state of affairs. He has provided many exceptions to the contrary where he continues to “try” in spite of all the difficulties he’s facing. Just in coming into therapy today he continues to try and make things better. We reflect this to him but he is hesitant to accept this as a personal strength.
Shawne: But it sounds like you do keep trying even when these things happen to you that. Like you said you lose everything and then you overcome it and you keep on and you work and it sounds like you take care of your daughter and you take care of your mom.
Client: But that the reason I’m working because of her. And I don’t know I guess, I guess, I don’t want to, I don’t want to quit because of my baby girl.
Shawne: Yeah, and you don’t sound like the type of person that’s a quitter anyway.
Brandy: I agree
Shawne: Yeah, it doesn’t sound like that would even be something you could do.
Brandy: I mean it seems like everybody in your family thinks you’re a strong willed person.
Shawne: Uh hmm, and that you get on your feet by your own work.
Client: Yeah
Shawne: Yeah and so I
Client: It was my mother in law that helped me the first time. I just
Shawne: Uh hmm
Client: Today when I was crying in the middle of the parking lot I was just like there’s nothing I can do. I felt like I can’t, I still feel like that a little. It’s like no matter how hard I try.
Shawne: Uh hmm
Client: Yeah. That really what I got to say cause that’s everything that’s bothering me, almost everything.
Shawne: Yeah. That’s a lot of stuff, and that’s why I’m still like wondering how, with all that stuff, you’re still even able to get up, even come back over here. I mean you could have said yeah, I’ll be back and then
Brandy: Not show up.
Shawne: Not show up but you still came back. That to me shows that you’re the kind of person that doesn’t quit and a responsible guy. I mean if you say you’re going to do something then you going to do it.
Comments: At this time he states that when he was not seen immediately his mother and girlfriend took him to talk to a priest. He said it helped him a little and that is why he was able to come back to counseling. He also talks more about his brother in law. He said he is trying to get his landscaping company of the ground and he had gotten paid for a job. He said he gave his brother in law his half of the money but he did not show up to help him finish the job. He said he could not face having to do the work himself and that was one of the reasons he was at the clinic today. He said his brother in law told him he was hung over and could not work. He said he was contemplating firing him but then his girlfriend would be mad.
Client: I just don’t know what to do like, if I fire him he has two kids, I have one.
Shawne: Uh hmm
Client: If I fire him, she’s going to get mad at me. I’m just you know I can’t help it. I just, I don’t know what to do. I would like ya’lls opinion. Should I fire him? I don’t know cause, that’s one of, that’s one of my problems.
Shawne: Yeah.
Client: I don’t know what to say like this. Its I think I should because that would be a good bosses decision but that would be a brother in law decision would be no. You know what I mean?
Shawne: Uh hmm
Client: Like its like a split down the middle, like I don’t know what to do.
Shawne: Yeah.
Client: So I didn’t go work today I actually came here. This is where they took me. My girlfriend told my mom, which I obey my moms every word, I just came here. I just don’t know what to do from here now.
Shawne: Yeah. Well it sounds like you have an idea of what you should do to me.
Comment: Here we reflect the ambivalence he is feeling regarding what to do about his brother in law. He has made a case to us as to why he should fire his brother in law but still concerns himself with how that will make the brother in law feel. In making the case for firing him he appears to have made a decision about what to do and is struggling with how to go about doing it. He struggles between being a boss and a brother in law. We continue to elicit exceptions such as his compassion and reasoning skills. We continue to support his position as expert.
Client: A little one but like
Shawne: Yeah and that’s why I’m sure you’ve heard this before they say you shouldn’t do business with family. I’m mean we’ve all done it don’t get me wrong. I mean we’ve all done it and we think man how to we get out of this now without you know making so and so mad, and hurting this person and it can be hard. And so I can understand why you having such a hard time with it but like you said you also have a child to take care of and raise, and that you want to make money for and it sounds like you make pretty good decisions when it comes to those things. And knowing that, that you’re a good decision maker and you’re a responsible person, I think you are the best judge of what to do in that situation.
Therapeutic Gallery
At this point we enter into the therapeutic gallery when we recognize and reaffirm John’s good decision making skills. We help him acknowledge that he has already made his decision, and because he’s such a good decision maker, it will be the right decision for him. We also normalize the conflict he feels about the decision he has to make and that his feelings about his situation are understandable. We also assign him homework that will help him plan how to communicate with his brother in law. By the end of the session he states he “still feels like crap,” however it is less than when he entered the session.
Client: like the me you see right now is not me. When I’m cutting yards and then getting customers and stuff I’m actually in your face, how’s it going, you know stuff like that.
Shawne: (the team phones in) that was the team and they had a couple of questions um, kind of some stuff they were curious about because of the things that you had mentioned and um one of them was because you seem to be looking kind of for feedback and for advice, and they were just wondering if you could ask the friend who passed away for advice, what do you think he would tell you about what you’re going through now?
Client: Man, I miss that dude, he would tell me to ignore it and keep on going and then we’d kick it and play basketball or something.
Shawne: Yeah
Client: That’s what he would tell me.
Shawne: Yeah.
Client: I its just, I guess, I guess I ya’ll know what ya’ll talking about because that fool was a really close friend of mine.
Shawne: Uh hmm. And it sounds like it the way you talked about him. Even though you talked about him just for a moment you could tell that person was that he was important and still is to, you know, to a certain degree in your life.
Client: Yeah my friend was a good guy, he didn’t deserve to get shot.
Shawne: Well it took a little bit longer but the team really had a lot of feedback and a lot of things they wanted to say um. And first and foremost they understand that this has been a bad day for you and you’ve got so many things going on that you’ve mentioned. You know you’re talking about possibly firing your brother in law, and then the money issue, and then the loss of your friend. It seems like you’ve had a lot of losses so even though you may not agree with what the teams feed back is, we did want to um share it with you and that they feel that in spite of all that stuff you have a lot going for you. They have a lot that they want to praise you for in the sense that you’re responsible, you put your daughter first and foremost even though you’ve got all these things going on for yourself. That you worry about how other people are going to feel even though you need to do what’s right for you as well. You’re looking at your brother in law even though you said he’s been a bad employee your still concerned about him and his family. And so they were really just impressed with um everything you’re managing to do in spite of the losses. And they recognize that because it’s been such a bad day you might not see it that way right now, but
Client: Yeah, I understand
Shawne: Yeah but they wanted for us to share that with you because they were just so impressed and they felt that you have a lot of things to really hold your head up high about because your able to, able to still put your daughter first, and take care of her and worry about all those things that a father does. Even though you say you can’t be there you say you’re still working to provide her diapers, and food, and clothes, and all those things that are important to raise a healthy baby. So, I mean it sounds like you have an idea of what you should be as a father, but your doing those things by working and providing and trying to do the best even with the situation as it is. So they were just really you know impressed with how you really want to set that good example for your daughter. And so they wanted, they wanted to share that with you.
Client: Yeah, that’s nice
Shawne: And to let you know that you do have a lot of things to hold your head up high about. Having talked about your brother in law, you kind of like I said, already made a decision, so maybe the best thing for you to do at this point is just to figure out the best way to talk to him that’s going to make you feel okay with it. You know what I’m saying. Do it in a way that you think, you know what I said what I had to say, in the right way, you know with respect, and with kindness and now that’s the way it going to be. And he’ll have to deal with his feelings but
Client: Yeah that’s true
Shawne: You want to say it in a way where you feel you know what I did it the right way, I did it in the best way and that’s all you can do.
Client: Yeah cause he didn’t work out right.
Shawne: Yeah
Client: I don’t have to feel bad
Shawne: Uh hmm, but you don’t have to do it in a way that says you know
Client: I know I’m going to ask you a stupid question but the point is I just don’t want to feel bad.
Shawne: Of course but I don’t know if that
Client: Is it worth it
Shawne: If that’s realistic. I mean you told us, you made a good case to us why you should fire him
Client: Yeah
Shawne: So you are just going to
Client: That’s because I was mad about it, when I was mad I was just like
Shawne: And now that you’re a little bit calmer, and you’ve thought about it, you can do it in a way that is more I guess professional, like an employer would do.
Client: Yeah
Shawne: Cause you’ve got to take care of yourself
Client: Yeah, I’m letting you know something don’t hire him. Thank you for talking to me.
At the end of the session he states that he will make an appointment for 3-4 weeks out which really surprised us. We assumed because he felt his situation was so bad and he stated he was depressed he would need to return sooner. He then decided he had gotten what he needed which was to be reassured about his decision to fire his brother in law and he would call if he needed another appointment.
Another surprise is that right before leaving the room John tells us he is uncomfortable talking to women because of the relationship he has with his sisters. We assured him that he could see a male therapist in the future if that would be helpful for him so he could return for another session. He assured us we were helpful to him and he did not feel he needed to schedule another session at this time.
John was a client who presented with so many problems that it would appear his case could not be addressed much less helped in a single session. Even as we began the session we were unsure if there was going to be anything we could do in one hour that would be helpful to him. He was easy to work with in that he had numerous exceptions and strengths which allowed us to move through from the presenting gallery, through the resource gallery to the therapeutic gallery with relative ease. He provided several exit markers from gallery to gallery however there were times in which he was not ready to move through those exits. Early on in the session he would exit the presenting gallery to the resource gallery only to reenter the presenting gallery by providing a new problem frame. It was more of a revolving door between the presenting and resource galleries. As we moved through the session the exit doors were able to be closed and we moved forward to the therapeutic gallery. By the end of the session he was able to smile and made eye contact before leaving the session.
Graphic Representation of Analysis
· Lost both jobs
· Not spending time with daughter
· Being financially strapped
· Kicked out of school
· Car was totaled and towed away
· “Went Off”
· Yelling at Mother and Girlfriend
· “ I’m in a hole”
· Can’t do anything
· Feeling ashamed
· Inferior
· Feel like the world has screwed him over
· No one can help him
· Lost his job
· Financially strapped
· Idea of “Father”
· Deciding whether or not to fire his brother in law
· Best Friend killed
· Finds out information about girlfriend
· Transportation
· Yelling at Mother and Girlfriend
· Breaking down and crying
· Asking for help
· Interactions with brother in law
· Find a way to fire brother in law in a way that he feels good about
· Ask his friend who passed away for advice
· How has he managed to do as well as his has?
· Client: I was never around for my daughter because I was always working
o Therapist: You were working to provide all the things your daughter needs to be happy and healthy
· Client: I need advice on firing brother in law
o Therapist: Seems like you already made a decision and need to find a way to tell him that you feel ok with
· Client: I can’t do anything
o Therapist: You have managed to have two jobs, take care of a daughter, start your own business, and make good decisions
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